📋 Tender Overview
The proposal now sent to the Senate for a second step contemplates making this insurance effective through special financial coverage in the modality of Fonasas free choice care.Creating health insurance for the middle class through special financial coverage in the modality of free choice care of Fonasa bulletin 12.662 is the objective of the project approved by the Chamber of Deputies Chamber and dispatched to the second procedure at Senate.The initiative had its most discussed point in the definition of a deductible and the maximum annual expenditure per beneficiary. The initial proposal entered for processing by the Executive in May of this year raised an even rate for all the sections however this was varied by means of an indication from the Executive that reduced the amount for section A in both aspects.Despite the foregoing much of the opposition expressed its opposition to the initiative. He considered it insufficient for the needs of the population criticized that a co-payment system be maintained and that public health not be strengthened and also demanded the permanence of Minister Jaime Maalich in the cabinet among other considerations.On the contrary the government considered that the proposal is an advance that will improve treatment opportunities for more than 80 thousand beneficiaries by lowering costs for users which is estimated to also facilitate lowering waiting lists in the public system. In addition it was recalled that a prioritization of hospital centers is made starting with the public system.In this context the vote in general registered 78 favorable votes 58 against and six abstentions. Then the financing modality was ratified by 75 votes in favor 66 against and three abstentions.Next four other votes were verified that allowed the approval of standards perfected in the Finance Commission the basic text was raised by the Finance Commission and that in the substantive they reduced the terms in which the regulations of this law should be available and therefore the application of legal merit.Project dataThe project presented through the texts of the Health and Finance Commissions which Ricardo Celis PPD andJos Miguel Ortiz DC establishes in the Modality of Free Choice a special financial coverage which will be called Catastrophic Insurance for surgical interventions and disease treatment .Such covered interventions and treatments must include the set of benefits codified or not necessary for the comprehensive resolution of the health problem such as hospital and outpatient medications hospital supplies medical fees hospitalizations post-hospital care and post-operative complications up to thirty days after surgery according to the respective medical indication.The Undersecretariat of Public Health will propose together with the annual budget formulation the list of priority interventions and treatments to be financed with insurance through the definition of priority benefit baskets prepared on the basis of a regulated health prioritization that Consider stages of evaluation of evidence and participation of a conflict-free committee.For the aforementioned the health priority established for this purpose by the Ministry of Health must be in sight a quantitative analysis of waiting lists of those benefits that are not guaranteed in order to determine the needs of the population an analysis of the public and private offer available for the delivery of said health benefits and an analysis of the cost and effectiveness of each of the benefits to include.For the granting of each of the interventions and treatments defined Fonasa will preferably sign agreements with providers of the National Health Services System or other public university or non-profit providers. If there is not enough offer agreements can be signed with private providers.The award of the agreements must be preceded by a public tender in which a reference tariff will be established in the bases that will be mandatory for the provider.Beneficiaries of the systemThey may make use of the coverage of this insurance all Fonasa beneficiaries who are in any section who are accredited in the six calendar months prior to the month of its activation.These interventions and treatments that the insurance will include will be financed jointly between the National Health Fund and the beneficiary as followsThrough a deductible which the beneficiary will bear and which will correspond to the sum of the expenses generated in each intervention or treatment which will be the equivalent of 4.8 times the monthly family income divided by the total number of beneficiaries of said group constituted by the affiliate and the beneficiaries that depend on him.This deductible may not be less than 4.8 monthly minimum income for the beneficiaries of sections B C and D and 2.5 times said monthly minimum income 752000 for those of section A.Above the amount Just mentioned the expenses associated with each of the interventions and treatments covered will be fully charged to the National Health Fund.The maximum annual expenditure per beneficiary that the member must bear if there is more than one intervention or treatment in the period between January 1 and December 31 of the respective year will correspond to 4.8 times their income monthly family divided by the total number of beneficiaries of this group consisting of the affiliate and the beneficiaries that depend on it.Said maximum expense may not be less than 4.8 monthly minimum income for the beneficiaries of sections B C and D or 3.8 monthly minimum income 1143000 for section A.
